Purpose The effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital.

Methods Using Maryland inpatient discharge data via a retrospective study, the authors compared cost and outcome data for a hospital with more than one half of the cases in the state to all other hospital providers as a group and with smaller groupings according to the volume of procedures performed.

Results Hospital mortality, length of stay, and costs were significantly less at the high-volume regional medical center when compared with all other hospitals.

Mortality and cost increased as volume decreased when hospitals were grouped according to volume.

Conclusions An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.